尿转化生长因子-β1 作为蛋白尿性肾脏疾病中血管紧张素 II 受体阻滞剂抗蛋白尿反应的指标。

Urinary TGF-beta1 as an indicator of antiproteinuric response to angiotensin II receptor blocker in proteinuric renal diseases.

机构信息

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.

出版信息

Biomed Pharmacother. 2009 Nov;63(9):672-8. doi: 10.1016/j.biopha.2009.02.002. Epub 2009 Feb 28.

DOI:10.1016/j.biopha.2009.02.002

PMID:19278811

Abstract

BACKGROUND

Angiotensin II receptor blockers (ARBs) reduce proteinuria, however, with large inter-individual variability. The present study investigated whether urinary transforming growth factor-beta1 (TGF-beta1) might predict the antiproteinuric efficacy of ARB in non-diabetic chronic renal disease.

METHODS

Non-diabetic patients with proteinuria (>1 g/day) received 50 mg of losartan daily followed by 100 mg in two treatment periods, each lasting 12 weeks. Clinical parameters and urinary TGF-beta1 levels were measured at baseline and during the treatment period.

RESULTS

In the whole group of patients, losartan treatment effectively decreased proteinuria. However, considerable differences existed among individual antiproteinuric responses. Good (n=34) or low (n=15) responders showed average proteinuria reduction of 69% or 17% from baseline, respectively. Both groups showed similar baseline biochemical and renal parameters and comparable degree of mean arterial blood pressure (MAP) reduction. However, the low responders were older and showed significantly higher baseline urinary TGF-beta1 levels. On multiple regression analysis, age, baseline urinary TGF-beta1 and % reduction in urinary TGF-beta1 and % reduction in MAP significantly predicted antiproteinuric response to losartan therapy.

CONCLUSION

The present data suggest that the determination of baseline urinary TGF-beta1 could be an useful indicator of short-term antiproteinuric response to ARB treatment in non-diabetic nephropathy.

摘要

背景

血管紧张素Ⅱ受体阻滞剂（ARB）可减少蛋白尿，但个体间差异较大。本研究旨在探讨尿转化生长因子-β1（TGF-β1）是否可预测 ARB 治疗非糖尿病性慢性肾病的降蛋白疗效。

方法

蛋白尿（>1 g/天）的非糖尿病患者接受每日 50mg 氯沙坦治疗，然后在两个治疗期各接受 100mg 治疗，每个治疗期持续 12 周。在基线和治疗期间测量临床参数和尿 TGF-β1 水平。

结果

在整个患者组中，氯沙坦治疗可有效降低蛋白尿。然而，个体间的降蛋白反应存在显著差异。良好（n=34）或低（n=15）反应者的蛋白尿分别平均降低了 69%和 17%。两组的基线生化和肾脏参数相似，平均动脉压（MAP）降低程度相当。然而，低反应者年龄较大，基线尿 TGF-β1 水平显著较高。多元回归分析显示，年龄、基线尿 TGF-β1 以及尿 TGF-β1 降低百分比和 MAP 降低百分比与氯沙坦治疗的降蛋白反应显著相关。